1. Hypertension or elevated blood pressure is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases.
2. According to WHO 2019, an estimated 1.13 billion people worldwide have hypertension, most (two-thirds) living in low- and middle-income countries.
3. In 2015, 25% of men and 20% of women had hypertension.
4. Hypertension is a major cause of premature death worldwide.
5. One of the global targets for non-communicable diseases is to reduce the prevalence of hypertension by 25% by 2025.
What is hypertension?
1. Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high.
2. Blood pressure is written as 2 numbers.
▪The first one is systolic blood pressure which is defined as the pressure in blood vessels when the heart contracts.
▪The second one is diastolic blood pressure which is defined as the pressure in the vessels when the heart rests between beats.
3. Hypertension is diagnosed when systolic blood pressure is higher than 140mmHg and/or diastolic blood pressure higher than 90mmHg.
Risk factors
| Modifiable | Non-modifiable |
| 1.Unhealthy diet ▪High salt intake ▪Low potassium intake ▪High saturated fat & trans fat intake ▪Low intake of fruit & vegetable 2.Physical inactivity 3.Smoking 4.Alcoholic consumption 5.Being overweight or obese 6.Stressful lifestyle | 1.Family history of hypertension 2.Aging factor (above 64 years old) 3.Presence of co-existing diseases ▪Diabetes ▪Kidney failure ▪High blood fat |
Sign and Symptom
1. Hypertension is a silent killer which will show almost no symptom; therefore, a lot of people tend to unaware of it.
2. When symptoms occur, you may feel
▪Early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears.
3.Severe hypertension causes
▪Fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.
Complications of uncontrolled hypertension
1. Cause serious damage to the heart & excessive pressure can harden arteries, decreasing the flow of blood and oxygen to the heart.
2. Elevated blood pressure and reduction of blood flow can lead to
▪Chest pain (angina pectoralis)
▪Heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die from lack of oxygen. The longer the blood flow is blocked, the greater the damage to the heart.
▪Heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs.
▪An irregular heartbeat can lead to sudden death.
3. Hypertension can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke as well as an aneurysm.
4. Hypertension can cause kidney damage, leading to kidney failure.
Prevention of Hypertension
1.Prevention
▪Reducing salt intake (to less than 5g daily)
▪Eating more fruit and vegetables
▪Being physically active on a regular basis
▪Avoiding the use of tobacco
▪Reducing alcohol consumption
▪Limiting the intake of foods high in saturated fats
▪Eliminating/reducing trans fats in the diet
2.Management
▪Reducing and managing mental stress
▪Regularly checking blood pressure
▪Treating high blood pressure
▪Managing other medical conditions
Diagnosis of Hypertension
1.Normal blood pressure: below 120/80mmHg
2.Elevated blood pressure: 120-129/80mmHg
3.Stage 1 hypertension: 130-139/80-89mmHg
4.Stage 2 hypertension: above 140/90mmHg
Treatment
1. The first line of treatment should always be lifestyle changes
▪Eating a heart-healthy diet with less salt, high potassium, as well as high fruit and vegetables
▪Getting regular physical activity of at least 30 minutes per day and 5 days a week (or 150 minutes per week)
▪Maintaining a healthy weight or losing weight if you’re overweight or obese (BMI between 18 to 22.5kg/m2)
▪Limiting the amount of alcohol you drink
▪Quit smoking
▪Managing stress
▪Monitor blood pressure at home using BP machine
2. The goal of blood pressure should be below 130/80mmHg
Guidelines to cut-down sodium intake (<2400mg per day)
▪Limit sodium intake to less than 2400mg per day, equivalent to 5g or 1 teaspoon
▪Eliminate salty food from the diet, sea salt is no better than table salt.
▪Choose low sodium food, which is defined as less than 140mg per serving
▪Get potassium salt as a salt substitute (it can both lower sodium intake and increase potassium intake)
▪Be creative and season your foods with spices, herbs, lemon, garlic, ginger, vinegar and pepper. Remove the salt shaker from the table.
▪Avoid high sodium food, which is defined as more than 400mg per serving (processed food, MSG)
▪Eat more home-cooked food
Guidelines to consume more potassium (>3500mg per day)
1.Consume more fresh fruit juices
2. Add leafy vegetables into your home-cooked meal
3. Add a more leafy vegetable into your sandwich and salad
4. It is OK to consume leafy vegetable gravy
5. Toss in fresh or dried fruits into your yogurt
6. Enjoy baked potato instead of bread as your breakfast
Tips to reduce trans fat
1. Trans fat is found in processed food, it is produced by the hydrogenation of unsaturated fatty acid in saturated fatty acids. It can bring destructive effect to cardiovascular system; therefore, must be omitted from the diet.
2. The guidelines are as follow:
▪Eat more whole foods like fruits, vegetables, whole grains, beans, lean meats, fish, nuts, and lean poultry. Avoid inner aisles where you’re more likely to find processed foods that may contain trans fats.
▪Cut back on the consumption of processed foods. Eat these foods less often and in smaller portions.
▪Not all processed foods contain trans fats. When you do eat processed foods, avoid processed foods known to contain trans fats such as chips, cookies, donuts, icing, cakes, biscuits, microwave popcorn, crackers, fried fast foods and frozen pizzas.
▪Read food labels and avoid foods with partially hydrogenated oil listed as an ingredient.
▪Avoid stick margarine and vegetable shortening. Swap this for olive oil, grape seed oil, canola oil, soybean oil, corn oil, or sunflower oil when baking or preparing meals at home.
▪Whether dining in or out, avoid fried foods. Choose foods that are baked, steamed, broiled, or grilled.
Medications (come next if lifestyle changes failed)
1. Thiazide diuretic: helps the kidney to eliminate sodium and water; which reduces blood volume and blood pressure.
2. Angiotensin-converting enzyme (ACE) inhibitors: help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
3. Angiotensin II receptor blockers (ARBs): help relax blood vessels by blocking the action of an angiotensin II that narrows blood vessels.
4.Calcium channel blockers: help to relax the smooth muscles of blood vessels; hence, lowering the tension.
5.Alpha-blockers: reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
6.Alpha-beta blockers: slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
7.Beta-blockers: reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force.
8. Aldosterone antagonists: blocks the effect of aldosterone that cause fluid retention in order to reduce blood volume and pressure.
9.Renin-inhibitors: inhibitor renin to be produced by the kidney
10. Vasodilators
11. Central-acting agents.: prevent your brain from signaling the nervous system to increase heart rate and narrow blood vessels.
Alternative Medicine
1.Supplements that increase nitric oxide production or widen arteries: coenzyme Q10 and L-arginine
2.Omega 3 fatty acids
3.Minerals: magnesium, calcium and potassium
▪Minerals are very important in controlling the relaxation of the heart and blood vessels.
4.Herbal remedy: grape seed extracts
a)Coenzyme Q10-150mg
- Naturally produced body; however, production is reduced by aging, smoking, physical inactivity, obesity, diabetic, uncontrolled emotion, high cholesterol intake, taking antihypertensive medication and statin drugs.
- It helps to fuel the heart and body with oxygen & energy needed by extracting electron from food. When the heart gets enough oxygen from food with the help of CoQ10, it will have a stronger pump power & ability to pump the blood to the other parts of the body
- Heart failure is due to the heart not getting adequate nutrients & oxygen due to hypertension & CHD. Myocardium & blood vessel will injure & inflamed with the lack of oxygen. These will make the heart unable to pump well. To make things worse, medication for hypertension & hypercholesterolemia decrease the CoQ10 level in the body; further, increase risk of congestive heart failure.
- CoQ10 also acts as an antioxidant to protect cell membranes & arterial tissue from oxidative stress & inflammation that cause hardening of the blood vessels. It helps to increase mitochondrial function in producing energy & oxygen for brain cells in order to prevent Parkinson & Alzheimer’s diseases as the brain is very susceptible to oxidative damage due to its high fatty acid content and its high demand for oxygen.
- CoQ10 is also able to thin the blood, reducing its viscosity; hence, reducing blood pressure & vascular resistance.
b)Nattokinase-50mg
- It is a fibrinolytic agent to break down fibrin that causes thrombosis & embolism. These enzyme breaks down & dissolves blood clots in order to enhance the ability to fight blood clotting. Blood pressure can be lowered after blood clots dissolved as vascular resistance & blood viscosity reduced.
c)L-carnitine fumarate-50mg
- It helps mitochondria (found most abundant in skeletal muscle, brain cells, myocardial cells & sperms) to use fatty acids as energy source effectively reducing blood fat & cholesterol.
- Similar to CoQ10, it helps the heart to improve oxygen usage & energy metabolism by heart muscles; hence reducing angina pectoralis. Together with Q10, it helps to reduce myocardial injury, irregular heartbeat, and congestive heart failure.
d)Vitamin D3-200IU
- It reduces CHD risk by reducing metabolic syndrome & thickening of the arterial wall (metabolic pathways not known)
A.EPA 600mg, DHA 300mg
a)Lower risk of heart disease
- Helps to lower total cholesterol, triglycerides, LDL-cholesterol level in blood; hence, reducing the risk of arteriosclerosis & cholesterol crystal plaques.
- Omega 3 is also a blood-thinning agent to reduce viscosity; hence, reducing the vascular resistance that causes hypertension.
- Reduce liver fat that contributes to hypercholesterolemia; hence reducing the risk of ischemic heart failure due to high cholesterol
b)Support brain health
- It protects fatty acid-rich brain cells from oxidative stress by reducing inflammation on brain tissue
- Reduce vascular resistance to increase blood flow to the brain; which can help to decrease the risk of age-related mental decline & slow down age-related memory loss.
B.Sea buckthorn seed oil 50mg
- Omega 3, 6, 7 and 9 that have a strong antioxidant and anti-inflammation properties to protect blood vessel & brain cells from oxidative stress
C.Vitamin D 300iu
- It reduces CHD risk by reducing metabolic syndrome & thickening of the arterial wall (metabolic pathways not known)
BIOBAY Lcyoper Plus (contain 100mg of grape seed extracts)
1. Grape seed extracts are rich in oligomeric proanthocyanidins (OPC) antioxidants.
2. A review of 16 studies in 810 people with high blood pressure or an elevated risk of it found that taking 100–2,000 mg of GSE daily significantly reduced systolic and diastolic blood pressure by an average of 6.08 mmHg and 2.8 mmHg, respectively.
3. According to Zhang et al (2016), the most promising results came from lower doses of 100–800 mg daily for 8–16 weeks, rather than a single dose of 800 mg or more.
4. Another study in 29 adults with high blood pressure found that taking 300 mg of GSE daily lowered systolic blood pressure by 5.6% and diastolic blood pressure by 4.7% after 6 weeks (Park et al 2016).
5. Therefore, 2 to 4 tablets of Lycoper Plus in 2 divided doses is strongly recommended to help in managing hypertension.
References:
1.Eunyoung Park 1, Indika Edirisinghe, Ying Yng Choy, Andrew Waterhouse, Britt Burton-Freeman (2016). Effects of grape seed extract beverage on blood pressure and metabolic indices in individuals with pre-hypertension: a randomized, double-blinded, two-arm, parallel, placebo-controlled trial. Br J Nutr. 2016 Jan 28;115(2):226-38.
2.Zhang H, Liu S, Li L, et al. The impact of grape seed extract treatment on blood pressure changes: A meta-analysis of 16 randomized controlled trials. Medicine (Baltimore). 2016;95(33):e4247.
